I took a break, Mark’s death took a lot of energy.  I honestly needed to step back from the weirdness of losing a co-worker in such a violent self-inflicted manner. I thought that after I got the story out on the last podcast, I would be good, the catharsis would happen, and I would feel the way back to my snarky and critical self on paper.

Well, that didn’t fucking happen. I wasn’t awash in some kind of strange grief, I really just didn’t feel like doing those things outside of going to work and coming home. It didn’t help that this fell about the same time as the anniversary of Ranger and Whitey leaving us across the rainbow bridge. I think I really was smacked by a considerable moral injury. The kind that just leaves you on the edge of…ugh.

I was not despondent or on the verge of self-harm, or even withdrawal from those around me. I think I just needed a step back, chill-out, and catch my breath. I have; goodbye, Mark, you left a lasting impression on all of us for sure.

I have been delving into you-tube. Usually, I watch woodworking videos which are sedate and often stilted as people who have very little video presence. Still, tons of woodworking talent present their craft. YouTube of late started throwing these confrontational videos at me. Videos where I watch an entitled America and am forced to listen to one more “I need to speak to your manager” or “corporate will see this”…

Ok, back to business.

Thankfully I was never at a loss for the day to day patient care with the exciting challenges that are presented on an inpatient unit. One of the most exciting challenges is overcoming the concept that many “physical maladies” here are related to their psychiatric condition. I spend a great deal of time trying to make sure that the physical realm is cleared before we just run to a psychiatric diagnosis.

It isn’t uncommon when I am called to see a patient and hear a nurse or other staff member say, “she is a little borderline” or “he is just looking for secondary gain.” I have seen it be both psychiatric and physical or even a little of both. The trick is often sorting through the weeds while dealing with someone who may have those “issues.”

It is a huge pet peeve of mine when a medical provider tries to tell a patient that their condition is psychiatric. He then refuses to work up a patient because he has assumed that diagnosis. It is sheer laziness to assume anything. Stay in your lane Dick and do your diagnostics. It saves us a lot of time when that person must be worked up medically as an inpatient because you turfed them to the ER. Not that I don’t mind doing a workup, I just hate doing clean up for someone making a premature diagnosis or just failing to. It takes just as much time for you to push the buttons and order the tests as it does for me to do it.

Sometimes the case is unusual. A female on the ward started to show signs of an acute abdomen, so it became necessary to do the workup, which was interesting because it was in the middle of the night.  It involved coordination that I had not had to perform since I worked in the ER. We had quick results and prevented a transfer of the patient from our ward to a more acute setting.

In the end, the patient was actually in need of general surgery. We were able to consult them immediately (even at 2:30 in the morning).

This has sat for several days while I still generated the energy to finish my work. Keep with me kids, we will get this train out of the station.

Please be the kind of person your mom and your dog think you are.